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MGH Community News |
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MGH Community News |
| April 2017 | Volume 21 • Issue 4 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Diana Tran, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
Supplemental Security Income Applications Now Online and Expanded LEP Services- But Phone or In-Person Still Recommended The Social Security Administration (SSA) recently announced that If you meet certain requirements, you can now file Supplemental Security Income (SSI) and disability applications online at the same time. You can apply online if you:
If you started another application online before April 1, but haven’t submitted it, you can take advantage of this new service option and submit a disability and SSI application together. But is it a Good Idea? Applications for Social Security Disability Insurance (SSDI) have long been online, but advocates advise applicants to apply in-person or by phone if possible. While it appears easier to apply online, applications are complex. Applying with direct assistance from SSA staff allows them to guide the application, help ensure that questions are completed correctly and completely, and avoid errors and misunderstandings, which may increase the likelihood of a successful application. Expanding Service to Customers with Limited English Proficiency SSA also announced that people with limited English proficiency can now request an appointment online for an in-person claim or teleclaim in the language of their choice. With the availability of this new service in many languages, including Spanish, SSA is discontinuing the separate Spanish language iClaim option. Applicants who started and saved an iClaim in Spanish can still enter the portal and complete it for up to six months after the claim start date. -Adapted from Supplemental Security Income applications now online, SSA Blog, April 17, 2017 |
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SSI Recipients May be Receiving Reduced State Supplement Payments in Error SSP is the “State Supplement Program.” SSP pays a cash supplement to the Supplemental Security Income (SSI) program. The state-funded SSP program is designed to pay higher benefits for people who live alone than for those who share living expenses. However, it seems that some people who do live alone are being paid at the lower “shared living” rate.
If you know of SSP recipients who seem to be getting the wrong amount, you should encourage them to contact the Social Security Administration (if they get SSI and SSP) or the SSP Customer Service at 1-877-863-1128 (if they get only SSP) to request a change in their living arrangement of record. If your clients are being underpaid, they should be able to get the SSP benefits increased. The state may not agree to pay retroactive benefits, although Legal Aid believes legally they should. Community Legal Aid in Springfield is advocating on this issue and is seeking stories of clients impacted by this error. If your client is willing to share what happened to their SSI/SSP benefit, please complete this form and send it to:
Peter Benjamin Note: CLA cannot represent people individually, but the information will be very useful in trying to get a global solution to the problem. -Adapted from Low Income Elders/Persons with Disabilities may be receiving incorrectly low SSI/State Supplement Amount - Please flag cases, Food/SNAP Coalition listserv, on behalf of Pat Baker, Mass Law Reform Institute, April 18, 2017.
Heat & Eat (Helps Fuel Assist Households Get Higher SNAP Benefit) Moves to Twice Monthly Reporting DTA and the Department of Housing and Community Development (DHCD) have a special “Heat and Eat” Fuel Assistance program, or H-EAT. This program has helped thousands of elderly and disabled households qualify for higher SNAP benefits by enabling them to claim a significant income deduction. How does Heat and Heat work? The Heat and Eat (H-EAT) program provides a $21 fuel assistance payment to certain SNAP households that do not pay heating or cooling expenses and do not receive Low Income Energy Assistance Program payments (LIHEAP). This fuel assistance payment allows households to have SNAP benefits calculated using the Heating and Cooling Standard Utility Allowance (HCSUA) deduction from income, which means significantly higher SNAP benefits (the $21 is the trigger, not the main benefit of the program). The Department of Transitional Assistance (DTA) and the Department of Housing and Community Development (DHCD) exchange data to determine which households are eligible for the H-EAT benefit DTA recently shared in an Online Guide Transmittal that the Heat and Eat protocol has been modified. As of February 2017, households who are eligible for Heat and Eat will now be put on the Heat and Eat list twice a month (instead of only once a month). This is a helpful step in making this process easier and better for clients. Once on the list, DTA puts a $21 H-EAT Fuel Assistance payment on the EBT card and sends a benefits recalculation notice. Due to the Heat and Eat payment, the household’s SNAP will increase the following month. For households who continue to need Heat and Eat, DTA should "renew" (reissue) this $21 payment every 12 months. Households do not need to ask to be issued the H-EAT payment. It is an automated process. Case Examples:
Advocacy Tip: Contact an advocate if an elder or disabled person’s SNAP benefits suddenly go down. It could be that the annual H-EAT payment was not renewed. Advocates with questions about Heat and Eat may contact Vicky Negus at vnegus@mlri.org. -Adapted from SNAP Alert: Update on Heat and Eat program, Food/SNAP Coalition listserv, on behalf ofVictoria Negus, MLRI, April 10, 2017 and What is the standard utility allowance and what is H-EAT?, SNAP Advocacy Guide.
Hope Lodge Will Require Caregiver Unless Exempted A version of this article was e-mailed to the Oncology Social Work team earlier this month. Beginning on June 30th all Hope Lodge guests will be required to have a caregiver accompany them on their stay to assist the guest as needed to evacuate safely from the building in case of an emergency, secure medical assistance, and manage daily living tasks. Due to liability concerns, no Hope Lodge staff member may provide any physical or medical assistance to its guests. The policy change will not apply to guests that are checking-in prior to June 30 or current guests that have reservations extending through June 30. A health care professional may request an exemption from this policy if the guest isn’t able to have a caregiver with them for a variety of reasons. The Caregiver Exemption form requires the health care professional to ascertain that the patient is independent in self-care, does not have a history of falls, and could evacuate in case of emergency, among other criteria. See the form for details. Questions about this policy can be directed to Jamie Pernaa, Assistant Hope Lodge Manager 800- 227-2345.
Immigrants, Refugees Too Afraid to Seek Critical Help from Food Pantries, Domestic Violence Resources In Dorchester, a rumor that federal agents were lying in wait in the parking lot of a food pantry kept immigrants away. At Boston Medical Center, a woman seeking medical help fled after the front desk receptionist asked for her name and identification. In Chelsea, victims of domestic violence are so afraid of deportation, advocates say, they are reluctant to file restraining orders against their abusers. Across the state, many immigrants and refugees are too frightened by President Trump’s hard line on immigration to step forward for the most basic and critical of services, according to doctors, immigration lawyers, and advocacy groups. “This fear among refugee and immigrant communities is unprecedented,” said Dr. Sondra Crosby, who runs the Immigrant and Refugee Health program out of Boston Medical Center. Crosby and others who provide services to immigrants are scrambling to reassure vulnerable populations. Advocates for domestic abuse survivors have handed out pamphlets and cards explaining the legal rights of anyone who is detained or questioned about their immigration status. Boston Medical Center has sent out hundreds of letters to patients explaining that their immigration status and medical records won’t be released to the federal government. Crosby personally called incoming patients to reassure them they would be safe at the hospital. “We don’t want people to be afraid to get medical care,” she said. Federal statistics show that fears of a more aggressive immigration policy are not unfounded. In the first two months of Trump’s presidency, the number of federal arrests in Boston of unauthorized immigrants who had not committed a crime tripled to 156 compared with the same time period last year, when President Obama was still in office, according to numbers provided by US Immigration and Customs Enforcement. Immigrants, even those who have become US citizens, have become reluctant to register for any kind of service if it means providing a name and an address or any other personal information. she said. HarborCOV in Chelsea, an organization that helps survivors of domestic violence, holds a support group twice a month. Typically, 15 survivors will attend, but in recent weeks only one to three participants have shown up, said Kourou Pich, co-executive director of HarborCOV, which stands for Communities Overcoming Violence. Sixty percent of the nearly 1,000 adults and children helped by the group annually are immigrants and refugees. Victims who are legally in the United States or whose children were born here and qualify for state benefits such as food stamps and money for transportation have told service providers they are too afraid to collect them, Pich said. Immigration lawyers who are referred patients by the Massachusetts General Hospital Chelsea HealthCare Center have noticed the same pattern. A lawyer from the Lawyers’ Committee for Civil Rights and Economic Justice regularly uses a small office in the hospital to see patients with legal questions. Recently, fewer people are coming in, said Iván Espinoza-Madrigal, the committee’s executive director. “If an individual comes to the clinic reporting their child has been exposed to lead paint and we find out that the family continues to live in an apartment where lead is present, that’s where we would intervene legally,” Espinoza-Madrigal said. “We help immigrant families with children who are vulnerable, and if these individuals are not coming in for treatment and medical care, then those families cannot be referred to the lawyers.” He said his organization is trying to come up with legal strategies for health centers struggling to reassure patients. Lawyers and doctors at Boston Medical Center MC recently met for a similar purpose. “There is so much uncertainty,” Crosby said. “What can we honestly tell our patients when we don’t know ourselves what is coming down the pike?” -See the full Boston Globe article.
Protecting Assets and Child Custody in the Face of Deportation – Online Manual From Appleseed (a pro bono legal organization that focuses on broad systemic social initiatives): Can you imagine being abruptly ejected from the United States–and leaving behind your home, your children, your job, your bank account, and everything else you’ve spent years to build? Can you imagine what your children would feel when they arrived home and you’re gone? Deportation can be a cataclysm for families and communities, destroying decades of hard-earned assets and rupturing family development. That’s why advanced planning for financial and family issues is so important. And that’s why Appleseed is working with major law firms around the country to update its popular “Protecting Assets and Child Custody in the Face of Deportation” manual. This one-of-a-kind resource is designed for immigrants and those who work with them: the host of attorneys, nurses, social workers, religious workers who are stepping up in challenging times. Appleseed’s manual will help families develop plans in advance to deal with critical financial and family issues in the event of deportation, arrest and other emergencies. To access all of the chapters and preview those about to be released, visit the online Protecting Assets and Child Custody in the Face of Deportation Manual. Overview of the Manual Section 1: Child Custody and Related Children's Issues
Section 2: Personal Finance
Section 3: Personal Property
Section 4: Remittances
Section 5: Wages and Benefits
Section 6: Business
Section 7: Tax Implications - *NEW*
Section 8: Arrival in Mexico
You can sign up here to receive updates on these chapters as they are published. -Adapted from: http://www.appleseednetwork.org/updating-appleseeds-deportation-manual-child-custody-childrens-issues/ and Six New Chapters Released - Appleseed's Updated Deportation Manual, Appleseed Network listserv, April 14, 2017.
SNF Residents’ Rights Fact-Sheets Revised federal nursing facility regulations have increased protections for nursing facility residents and changed the rules for nursing facilities nationwide. Learn more in the three newest issue briefs from Justice in Aging:
All three issue briefs offer advocacy tips for consumers and their family members. Previous issue briefs focused on a variety of topics such as involuntary transfer and discharge and the use of unnecessary drugs, which is also the subject of a recent lawsuit brought by the AARP Foundation.
Exceptional Lives Resource Directory The Exceptional Lives website recently published the Exceptional Lives Resource Directory, a searchable online database of disability programs and providers in Massachusetts. Key populations are those with ADD/ADHD, Autism Spectrum Disorder, Bipolar Disorder, Cerebral Palsy, Down Syndrome and Intellectual Disability. The directory covers a wide variety of services including ABA Therapy, Social Skills groups, Animal Assisted Therapy, Respite care, Social and Recreational Activities groups, and many more. Other self-help guides on the website include the following topics Special Education, IEP, SSI, Health Insurance and Guardianship. (Requires setting up an account.) -Thanks to Clorinda Cottrell for forwarding.
Audit Finds $193M in Double-Payments from MassHealth for Behavioral Health The state has been double-paying for behavioral health services for MassHealth members, resulting in $193 million in improper or questionable payments to providers throughout the state according to Auditor Suzanne Bump’s office. The new report calls for the state medical insurance program to change its billings and claims process to prevent any future improper payments and recoup money improperly given out. The problem lies in how MassHealth, the state’s insurer for 1.9 million mostly low-income and disabled people, pays for behavioral health care. Rather than paying for those services directly, MassHealth contracts with Massachusetts Behavior Health Partnership to provide services on a fixed monthly fee. MBHP was paid $2.6 billion from July 2010 through June 2015 to manage these services for MassHealth members. The audit examined claims from July 2010 to June 2015 and found two areas of concern. First, the audit found that in addition to its monthly payments to the behavioral health partnership, providers have been billing and collecting payments through MassHealth — to the tune of $93 million. The analysis didn’t show if providers were additionally receiving reimbursements from MBHP. In addition, it found that MassHealth made about $100 million in questionable payments to providers for services such as family therapy sessions, behavioral health counseling, and psychological testing, according to the audit. Though those services hadn’t been specifically indicated as being covered by MBHP in the contract, Bump said they are behavioral health services in nature and should have been covered under MBHP. MassHealth contested the findings, and said it has been working since 2015 to better track payments.“The Baker-Polito Administration and MassHealth take the integrity of the Massachusetts Behavioral Health Partnership program seriously, and since 2015, have implemented major integrity initiatives and internal controls to better manage and evaluate claims within the MassHealth program’s structure, saving over $350 million," a spokesperson from MassHealth said. Yet rather than collecting reimbursements from MBHP, providers have been billing and collecting payments through MassHealth — to the tune of $93 million. The analysis didn’t show if providers were additionally receiving reimbursements from MBHP. All behavioral health services given in emergency rooms had also been paid out of MassHealth, rather than through MBHP. Rather than incentivizing MBHP to keep patients healthy to better manage them on a budget, MBHP was incentivized to allow members to frequently visit ERs. See the full articles:
Reasons to Use a Lawyer for MassHealth Planning Many seniors and their families don't use lawyers, whether for long-term care planning or assistance with the MassHealth application, often because they're afraid of the cost. Some take steps based on what they've heard from others, some do nothing, and others enlist non-lawyers to assist with MassHealth applications, often referred by nursing homes. Here's a few reasons to use an elder law attorney (from an elder law attorney):
The MassHealth rules provide opportunities for nursing home residents to preserve assets. There are more opportunities for those who plan ahead, but even at the last minute some steps are almost always still available to preserve some assets. It's always worth checking out whether these are steps you would like to take. -See the full Margolis & Bloom blog post.
MBTA approves budget – Avoids Major Cuts to The Ride, For Now This month the Massachusetts Bay Transportation Authority approved a nearly $2 billion budget that could privatize four bus garages and avoids — for now — most proposed service cuts to weekend commuter rail service and door-to-door van trips for riders with disabilities. The original budget cuts were intended to tackle a $42 million deficit that some criticized as misleading since the MBTA had access to additional state revenue. But after the proposals prompted an outcry from political leaders and riders, board members decided to bridge the gap with $30 million from those additional funds. At the same time, board members did not rule out some service cuts in the next fiscal year, and the budget calls for unspecified savings on commuter rail service and The Ride, the program for riders with disabilities. “It’s a far better budget for riders than the one that was on the table a month ago, but we still have concerns about potential cuts in the 2018 fiscal year,” said Charlie Ticotsky, the policy director of Transportation for Massachusetts, a coalition of organizations that lobby for better public transit. The budget included a number of reductions, including $1 million in savings from The Ride, which could mean the elimination of some trips. It is currently unclear how those savings are to be realized. -See the full Boston Globe article.
Disability Abuse Registry Proposed In an effort to prevent re-hiring caretakers with a documented history of abusing disabled people, state Rep. Linda Dean Campbell has proposed creating a state Disability Abuse Registry. "I filed legislation with 58 co-sponsors and considerable support among my colleagues and also from disabled person advocates that creates a registry of those who have been reported for abuse in caring for the disabled," Campbell said. "We met with many stakeholders to draft this legislation, including representatives from the Department of Developmental Services, as well as the Arc advocacy group." Campbell said the registry would list caretakers against whom a finding of abuse or the financial exploitation of a person with an intellectual or developmental disability was issued by the Disabled Person’s Protection Commission. Maura Sullivan, director of public affairs for the Arc of Massachusetts, which operates on behalf of people with intellectual and developmental disabilities, said not all cases of abuse and neglect rise to the level of criminality and that some of these cases can't be proven in a court of law. "For our clients, the kind of abuse that would not put someone in jail would be investigated by the Disabled Persons Protection Commission," Sullivan said. "At present, there is not a lot they can do other than have a person who has been substantiated of abuse and neglect fired. The biggest problem we have is that hundreds of those people just go find another caretaker job with another provider, and a criminal background check won't show anything." She said under this bill, it would be mandatory that if the DPPC substantiates abuse or neglect, the name of the person responsible would be added to the registry. "Right now, there is no way to track a person who has been substantiated of abuse or neglect by the DPPC, unless we get this registry up and running," Sullivan said. "At this time, there are more than 700 individuals who have been substantiated and whom we can't track. They are out there getting new jobs and working with vulnerable clients." The bill would allow for an appeal period, during which a caretaker's name would be listed with an asterisk. "Although it will not prevent all abuse, it will give providers one tool to check and prevent potential abuse," Campbell said. "The intent is to identify those abusers who are fired for this, only to be hired by another provider serving the disabled."
Several other states, including New York, New Jersey, and Illinois, have similar registries, she said. -See the full Eagle Tribune article.
Bill to Curtail Modern-Day Debtor’s Prison Massachusetts Gov. Charlie Baker wants to let criminal defendants who fail to pay fines or fees perform community service instead of going to jail. Baker is pushing a bill to allow the community service option, which he says will help create a fairer system where punishments fit better with crimes. Under current law, defendants who fail to pay fines, fees and assessments can be incarcerated until the debt is satisfied, at a rate of $30 a day. The bill will help defendants avoid jail by agreeing to community service. If a person still ends up behind bars for failing to pay, the bill triples the daily rate from $30 to $90, reducing the amount of time that the individual would need to spend behind bars to clear the debt. As noted in the MASSterlist daily news digest “Why it took so long to do this is baffling, considering that debtor’s prisons mostly went out of fashion in the 19th Century, except in our court systems....Two words: Long overdue.” -See the WCVB story. Additional content from MASSterlist, April 12, 2017.
Innovative Community Approach to Care for Those with Dementia in the Netherlands Located in The Netherlands town of Weesp is a special gated village called Hogeweyk. It is notable because it has been designed specifically as a pioneering care facility for elderly people with advanced dementia.
Hogeweyk seeks to optimize care for those with dementia by creating home-like village environments that invite walking and social interactions. The Hogeweyk village has streets, squares, gardens and a park where the residents can safely roam. Just like any other village Hogeweyk offers a selection of facilities, like a restaurant, a bar and a theatre whose staff are all trained in caring for those with dementia. These facilities can be used by Hogeweyk residents AND residents of the surrounding neighbourhoods. Learn more:
-Thanks to Barbara Moscowitz for sharing.
Lawmaker's Childhood Experience Drives New Mexico's 'Lunch Shaming' Ban When New Mexico state Sen. Michael Padilla was a child, he says he mopped the cafeteria floors to earn his school lunch, and he befriended the cafeteria workers so he wouldn't have to go hungry. "I grew up in foster homes, multiple foster homes," the Democratic lawmaker tells NPR's Rachel Martin. "It's very obvious who the poor kids are in the school."
He says students in circumstances like his often have to watch as other children get served a hot lunch, while they are given a piece of bread — with "maybe a little bit of cheese." "A 6-year-old maybe up to about an 11- or a 12–year-old, a 14-year-old, they have no power to fix this issue and to resolve this," Padilla says. "If their parents have debt in the lunchroom, then that is not something that they have control over, and I don't know why we're punishing them. So this prohibits that — it outlaws that — and it focuses more on the child's well-being rather than the debt itself." Padilla says the law is the first of its kind in the United States, but he has heard of lunch shaming happening "across the country." In 2015, a cafeteria worker from Colorado made national headlines when she claimed she was fired after feeding a first-grader who didn't have lunch money. A worker at a Pennsylvania school quit last year after she said she had to take away hot meals from two students. In New Mexico, schools will not only have to stop lunch shaming, they'll also have to make extra efforts to contact parents about debt. In cases where families qualify for federal subsidies, school officials must try to help them sign up for the benefits. Schools can still use other tactics, such as revoking a parking pass or withholding students’ transcripts, to get parents to pay. Under a new requirement from the USDA, every state in the country must clarify its policy on meal debt by July 1. It's up to the states, though, to decide how lenient or punitive they want to be about late payments. Two states, California and Texas, are currently considering legislation that mirrors New Mexico's. Some states, however, will likely leave it to school districts to define their policy. So far, the idea of putting the health of students over the health of school budgets has garnered rare bipartisan support. Padilla says he has already heard from legislators in other states who would like to use his bill as model legislation. "So I think you're going to see this kind of move its way across the country," he says. -See the full source articles from:
Lawmakers Want Hearing Aids to be Easier (and Cheaper) to Get, but Doctors Object New technology and a rare bipartisan push from lawmakers who are trying to reduce regulations for the sale of hearing aids are raising hopes that more people with mild to moderate hearing loss will be able to buy hearing devices a lot more cheaply and without seeing a doctor. It’s a modest-sounding goal, but supporters believe the measure on Capitol Hill could lower prices, spur innovation, and ultimately get hearing aids into the ears of far more people. Only 15 to 30 percent of people who need hearing aids actually get them, according to some estimates. Currently, regulations in most states, including Massachusetts, require consumers to go to a licensed audiologist or other specialist to purchase a hearing aid. The average cost: $2,300. Legislation sponsored by Democratic Massachusetts Senator Elizabeth Warren and Republican Senator Chuck Grassley of Iowa would supersede individual state rules and force over-the-counter hearing aids into the national market. It has the support of AARP, which is the largest lobbying group for seniors and advocates for people with hearing loss. But it is drawing opposition from hearing aid makers and a major trade association for audiologists. Supporters say the bill could unleash competition and put hearing aids that cost a few hundred dollars on the shelves. It could also foster technology that, among other benefits, allows consumers to use smartphones to control their hearing aids. “These new technologies are disrupting the marketplace, to the discomfort of a long-entrenched industry,” said Julie Kearney, vice president of regulatory affairs for the Consumer Technology Association, a major tech trade association that is lobbying for Warren’s bill. “But the technology is here and consumers deserve affordable choices.” Legacy hearing aid manufacturers and some groups representing audiologists aren’t enthusiastic. They warn it is dangerous to encourage people to self-diagnose hearing loss, which, untreated, can contribute to isolation, depression, and other bad health outcomes. They are skeptical that it will lead to more use of hearing aids. “We don’t ask them to do that for diabetes or hypertension. We always want to have medical professionals involved,” said Neil DiSarno, chief staff officer of the American Speech-Language-Hearing Association, a trade group for audiologists. There’s a web of reasons only a fraction of those people get hearing aids, experts say, including stigma and a confusing landscape of providers and services. But a big reason is cost: The average hearing aid costs more than $2,300. Most people need two. Medicare and most private insurance won’t cover a dime. Warren’s proposed solution: Have the FDA create a category of hearing aids for people with mild to moderate hearing loss that consumers can purchase from the neighborhood pharmacy or online — much like you can go into the store and buy a pair of nonprescription reading glasses. About two-thirds of those with hearing loss fall into the mild category, according to the Hearing Industries Association. Under Warren’s bill, the FDA would regulate the over-the-counter hearing aids, setting performance, safety, and labeling requirements. “With the right rules in place, safety will be assured, but costs will drop significantly, and that means a lot of people can get help they need,” Warren said. -See the full Boston Globe article.
Diaper Subsidy Proposal A proposal filed by Sen. Joan Lovely and Rep. Paul Tucker, both Salem Democrats, asks health officials to study creating a diaper subsidy for low-income families with children under 2 years old. “There’s no question that diapers are an absolute health necessity for babies, and some parents can’t afford it,” Lovely said. “This is a huge issue that needs to be addressed.” Diapers aren’t covered by federal food stamps, known as the Supplemental Nutrition Assistance Program. Nor are they provided by the Women, Infants and Children nutrition program, which classifies them with cigarettes and alcohol as invalid items. “You would think diapers would be included in these programs,” Lovely said. Welfare assistance can be applied to anything a family needs. But advocates say only 23 percent of poor families with children nationally receive benefits. In Massachusetts, the maximum amount of state assistance for a qualifying three-person family that lives in subsidized housing is $633 a month, advocates say. “Those benefits are extremely low,” said Deborah Harris, a staff attorney at the Massachusetts Law Reform Institute who specializes in public benefit issues. “Diapers are very expensive, and that’s a financial burden on many low-income families.” Harris said low-income parents often stretch out diapers, washing and reusing them, when supplies run low. That risks urinary tract infections and rashes. “There are severe negative public health consequences to not having a sufficient supply of diapers,” she said. Daycare centers require parents to furnish diapers for their children. Harris said parents who cannot afford them may decide to stay home with their children and not work. If the plan takes shape and is approved, Massachusetts would be the first state to provide diaper subsidies. In the meantime, families with an infant can pay nearly $1,000 per year on diapers, according to the National Diaper Bank Network, which estimates that an infant uses 240 diapers per month. One in three mothers have had trouble affording diapers, according to the group, which works with hundreds of nonprofit groups to collect and distribute diapers to low-income mothers. In Massachusetts, parents already get some help with diaper costs. The Bay State is one of seven — Rhode Island, Minnesota, New Jersey, New York, Pennsylvania and Vermont are the others — that exempt diapers and diaper liners from sales taxes. Plans for a wider subsidy are drawing criticism from those who believe the state’s welfare system is already too large. -See the full Salem News article.
Pretending Your Pet is a Service Animal Could Soon be Illegal Pretending your dog is a service animal is a harmless ruse, right? Wrong, disability advocates say. And in Massachusetts it could soon be against the law.
To crack down on the growing problem of fake service dogs, state legislators are considering a bill that would make it a civil offense to misrepresent a pet as a service animal. “Many of these organizations will simply ship someone with a disability what we like to call a dog in a box,” said Cathy Zemaitis, a spokeswoman for NEADS, a Princeton, Mass., nonprofit that trains service dogs. As a result, “someone with a disability thinks they’re getting a highly trained dog when in fact they’re getting a glorified pet, or worse.” Well-trained service dogs can press elevator buttons, retrieve dropped items, alert hearing-impaired people to doorbells and smoke alarms, provide balance to those with prosthetic limbs, sniff out life-threatening allergens, and sense when a person is having a medical emergency. For veterans with PTSD, they can prevent strangers from crowding too close. When phony service animals behave badly, they can make businesses skeptical of future customers claiming to have one. If ill-trained animals are aggressive, they can endanger their disabled owners.
“What’s happening is you get somebody who thinks it’s cute to slap a vest on Fluffy and take Fluffy to CVS. What’s the harm?” said Lowry Heussler, 55, of Cambridge, who uses a service dog to help her walk due to a congenital hip problem.
“The problem is that all the work we did of convincing the public that if you see a dog wearing a cape, that dog is safe and reliable and you don’t have to worry about anything — that work is being undone,” she said. Modeled after similar laws in Florida and Colorado, the bill filed in Massachusetts targets people who use fake service dogs to obtain privileges meant for the disabled, such as the right to take a dog into an airplane passenger cabin without paying a fee. If it becomes law, fakers could be fined up to $500 and required to do 30 hours of community service. The Americans with Disabilities Act defines a service animal as one “individually trained to do work or perform tasks for the benefit of an individual with a disability.” That applies only to dogs and miniature horses, and excludes animals needed mainly for psychological support, such as so-called emotional support dogs, comfort dogs, and therapy dogs. In a further complication, the US Department of Transportation allows emotional support animals on planes, although it is reconsidering its policy due to abuse, such as people reportedly bringing turkeys, pigs, and monkeys into passenger cabins. The Massachusetts bill would not apply to animals offering only psychological support. The ADA permits businesses to ask only two questions of someone claiming to have a service dog: Is the animal required because of a disability, and what work or tasks has the animal been trained to perform? But they can’t ask what the person’s disability is or ask the dog to demonstrate its skills. -See the full Boston Globe article.
Wisconsin Seeks To Mandate Drug Tests for Medicaid Recipients Low-income residents seeking government help in Wisconsin often slog through a frustrating, outdated bureaucracy at a run-down state building in Milwaukee, enduring a process that generates complaints about the difficulties of signing up for food assistance, unemployment benefits, and Medicaid. Now, in a first-in-the-nation experiment, Wisconsin Governor Scott Walker plans to raise the bar higher for people seeking Medicaid, with an expansive program of mandatory drug screening, testing, and treatment as a condition of receiving benefits. If the Trump administration approves Walker’s plan, as state officials expect once they submit a formal application next month, Wisconsin would become the first state to put a drug screening and testing requirement on coverage in the 53 years Medicaid has existed. “This could have sweeping consequences for poor people across the country,” said Hannah Katch, a health policy expert from the left-leaning Center on Budget and Policy Priorities. Walker next wants to impose drug testing as a condition for receiving other social services, including food stamps and unemployment benefits, he said in an interview with the Globe. Other states may follow Wisconsin’s lead, and critics of the Medicaid plan are already mobilizing. They believe it would unfairly stigmatize the poor and add more bureaucracy to what is already a complicated application process. State documents indicate that virtually all Medicaid recipients would be screened for illegal drug use through a written questionnaire when they apply for coverage or renew eligibility, although Walker maintains that details about who gets screened are still being worked out. When the screening indicates suspected drug abuse, the state will demand a physical drug test. People who refuse either screening or testing would not receive Medicaid benefits, according to Walker’s plan. Those who test positive for drugs would be required to undergo treatment or, if they refuse treatment, lose their benefits for six months. The state plans to expand access to residential treatment for people who need it, to meet the expected surge in demand. In addition to illegal drugs, the system will include screening and testing for legal opiates obtained without a proper prescription. That means the Medicaid crackdown will extend to the white, rural areas where the opioid epidemic has hit hardest, and where voters overwhelmingly backed President Trump’s 2016 campaign. Health care experts said Walker’s drug-testing plan — which has a projected price tag of about $50 million a year — would be ineffective, costly, and unjustly target impoverished minorities. According to the most recent data compiled by the Kaiser Family Foundation, 33 percent of Medicaid recipients in Wisconsin are black or Hispanic, a disproportionately high amount considering those groups make up 11 percent of the total state population. Health care specialists say there’s no evidence that tying people’s health insurance to a mandatory drug test will deter drug use. -See the full Boston Globe article.
Kentucky’s Medicaid Reform Proposes Cuts and Changes to Promote “Personal Responsibility” Kentucky is moving closer to an overhaul of the state's Medicaid program Gov. Matt Bevin has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most "able-bodied" adults who instead would have to earn them through a "rewards" program. Such changes could be enacted by January under a timetable laid out by Bevin's administration. State officials have said the administration expects preliminary approval for its proposal as early as June from the federal government, which provides most of the funding for Medicaid. Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, which is overseeing the plan, described the administration's proposal as one "tailored to meet the unique needs of Kentuckians" that mirrors commercial health plans and is meant to "better engage members in their own health, wellness, education and employability." It's also meant to improve health outcomes for Kentuckians, he said. But advocates and public health officials are increasingly concerned about what they believe will be an adverse effect on Kentuckians they say have benefited enormously under the Medicaid expansion launched in 2014 by Bevin's predecessor, former Gov. Steve Beshear. Advocates worry consumers won't understand the complex changes to the program and, as a result, will lose coverage. "I think people are going to fall away as the system gets more complicated," said Richard Seckel, director of the Kentucky Equal Justice Center in Lexington. "It's an experiment and there's some peril in it. Ideally, we'd be trying things that help people get coverage and keep coverage." Proposed changes include monthly premiums, co-payments for services, mandatory work or volunteer activity to maintain Medicaid coverage and "lock-outs" of coverage for up to six months for some who fail to pay premiums. The state proposal also includes a "My Rewards" account where people can accumulate points for activities such as passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes, points that go toward the purchase of services such as dental or vision care. But Medicaid members also would have points deducted from their rewards account for infractions such as failing to pay premiums or "inappropriate" use of emergency rooms up to a negative balance of $150. Critics of the requirement to work or volunteer up to 20 hours a week argue that a majority of adults affected by the changes already work, many in jobs such as food service, construction or housekeeping that don't come with health insurance. Collecting premiums and co-payments, tracking work or volunteer activity and managing the rewards accounts all will involve major technology systems changes and likely, hiring of outside vendors to manage such systems, advocates say. That adds to expense and potential complications, they said. "One scary possibility is that the systems crash like they did with Benefind," said Seckel, referring to the massive failure last year of a new state public benefit system that led to disruption of health coverage, food stamps and other assistance for thousands of Kentuckians. "With any kind of major technical modernization, there's some initial chaos." Seckel said other states that have attempted to impose modest premiums allowed by Medicaid have found that the cost of collecting monthly payments greatly exceeds any revenue the state takes in. Mark Carter, CEO of the Louisville-based Passport Health Plan, which manages care for about 300,000 Kentuckians, said his organization is working to prepare for the changes. Carter said the increased work will increase Passport's costs, which likely will mean more costs to the state Medicaid program. And he said it's inevitable some people won't understand the changes or be able to meet new demands and lose coverage. Both the state's dentists and optometrists urged the Bevin administration to consider restoring basic vision and dental services to its proposal. Instead, the administration agreed to offer such coverage only for the first three months for new members. After that, the benefits are available only through the "My Rewards" system for the adults considered "able-bodied," not including those who are disabled or "medically fragile," according to the state proposal. The changes also do not apply to pregnant women or children. -See the full Courier-Journal article.
Harnessing the Upsides of Stress Changing your mindset doesn't mean taking a Pollyanna view of the world. The key isn't to deny stress, but to recognize and acknowledge it — and then to find the upside, because a full-throttle fight-or-flight response is not the only possible reaction to stress (at least when the stress does not involve a potentially life-threatening situation). In people with a more stress-hardy mindset, the stress response is often tempered by the challenge response, which accounts for the so-called excite-and-delight experience that some people have in stressful situations, such as skydiving. Like the typical stress response, the challenge response also affects the cardiovascular system, but instead of constricting blood vessels and ramping up inflammation in anticipation of wounds, it allows for maximum blood flow, much like exercise. The balance of hormones is different too. Another modification to the stress response is called tend-and-befriend. It explains why, after the September 11 terrorist attacks in 2001, the 2013 Boston Marathon bombing, or the 2016 massacre at the Pulse nightclub in Orlando, people felt the need to reach out to friends and relatives in the community — to assure themselves that loved ones were all right, to comfort the distressed or bereaved, and to shore up social networks. Connecting in this way actually helps reduce stress as opposed to, say, watching an endless loop of TV coverage. That's because tend-and-befriend also involves different balances of hormones — in particular, increased levels of oxytocin, which enhances bonding between a mother and child or between sexual partners, for example. It makes the brain's reward centers more responsive to social contact, and it is an important part of resilience. Dialing back from full-on fight-or-flight can be simply a matter of changing your mindset. Studies have shown that when participants are told "You're the kind of person whose performance improves under pressure," it does — by as much as one-third. How can you shift your mindset? A 2015 book called The Upside of Stress by Kelly McGonigal gives multiple ideas. Here are just a few suggestions:
- From Harnessing the upsides of stress, HealthBeat, Harvard Medical School, April 22, 2017.
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